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Abstract

Reforms in the early 1980s created Chile's mixed system of health care
provision and finance. Since then Chileans have had to choose between a statesubsidised
public health insurance system or the private health plans offered by
several insurance companies. In the public system, users may be restricted to the
public facility network, with no choice of doctor or medical centre, or they may
opt for a free choice mode (preferred providers), which lets them choose both
doctor and place of attention. Private insurance providers offer a wide variety of
health plans, giving the customer a reasonable range of care options.
Although this public-private mix has now been operating for more than 20
years, there has been no empirical study of the factors determining the choice of
the preferred providers' mode by public beneficiaries. Likewise, few studies have
looked at the determinants in the choice between public and private insurance, and
the relationship between the latter choice and the use of health services.
The first two empirical chapters of this thesis look at the determinants of
these sources of choice, using different econometric tools: the choice of preferred
providers is examined using a logit model; the analysis into the choice between
public and private insurance uses a probit model; and the impact of holding
private insurance as a factor in determining use of health services is estimated
through a two-stage tobit model.
A further significant aspect of the reforms of the '80s was the process of
decentralisation for primary health care provision. Since then a substantial part of
preventive health care and promotion occurs locally, and among these services
children's health checks are an important policy objective. To encourage
attendance parents are given free food supplements if they keep to the timetable
for their child's check-ups. However these free food handouts partially account for
attendance at the check-ups. Thus the final empirical chapter of the thesis uses a
probabilistic model to look at the monetary and non-monetary factors that lead
parents to request health checks for their children.